1. GS TS BS LÊ HOÀNG NINH Biên soạn theo tài liệu của CDC, FDA Hoa kỳ,center for food security and public health…

2. Nội dung  Organisms  History  Epidemiology  Transmission  Foodborne illness  Prevention and Control Center for Food Security and Public Health Iowa State University 2004

3. Vi sinh vật  Estimated 250 foodborne pathogens  Foodborne illness  2 or more cases of a similar illness resulting from ingestion of a common food  Bacteria most common cause  Also viruses, parasites, natural and manufactured chemicals, and toxins from organisms Center for Food Security and Public Health Iowa State University 2004

4.  Foodborne disease outbreaks, cases and deaths  1993-1997  Salmonella had the highest number Center for Food Security and Public Health Iowa State University 2004

6. History  Early 1900’s  Contaminated food, milk and water caused many foodborne illnesses  Sanitary revolution  Sewage and water treatment  Hand-washing, sanitation  Pasteurization of milk- 1908  Refrigeration in homes- 1913 Center for Food Security and Public Health Iowa State University 2004

7. History  Animals identified as a source of foodborne pathogens  Improved animal care and feeding  Improved carcass processing  Surveillance and research  Outbreak investigations  Laws and policies regarding food handling Center for Food Security and Public Health Iowa State University 2004

9. Dịch tễ  Foodborne diseases each year in US  Affects 1 in 4 Americans  76 million illnesses  325,000 hospitalizations  5,000 deaths  1,500 of those deaths caused by Salmonella, Listeria, and Toxoplasma Center for Food Security and Public Health Iowa State University 2004

10. Epidemiology  Many unrecognized or unreported  Mild disease undetected  Same pathogens in water and person to person  Emerging pathogens unidentifiable  Greatest risk  Elderly  Children  Immunocompromised Center for Food Security and Public Health Iowa State University 2004

11. Giám sát / luật lệ  Surveillance  CDC  FoodNet and PulseNet  Regulation  FDA  Domestic and imported food  USDA FSIS  Meat, eggs, poultry  National Marine Fisheries Service Center for Food Security and Public Health Iowa State University 2004

12. Surveillance  FoodNet: Active surveillance  Established 1996  CDC, USDA, FDA, select state health departments  Nine sites in U.S. monitor 13% of U.S. population  California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, Tennessee Center for Food Security and Public Health Iowa State University 2004

13. Surveillance  PulseNet: Identify cause  Molecular fingerprinting  45 state public health labs certified  Passive surveillance: Survey methods  Hospital discharges  Outpatient treatment facilities  FoodBorne Disease Outbreak Surveillance System  All states submit outbreak data Center for Food Security and Public Health Iowa State University 2004

14. Chi phí  Economic Research Service - USDA  Cost of top 5 foodborne pathogens  $6.9 billion annually  Medical cost  Productivity losses (missed work)  Value estimate of premature death Center for Food Security and Public Health Iowa State University 2004

17. Transmission  Oral route  Contamination varies  Organism, reservoir, handling/processing, cross- contamination  Human reservoir  Norwalk-like virus, Campylobacter, Shigella  Animal reservoir  Campylobacter, Salmonella, E. coli 0157:H7, Listeria, and Toxoplasma Center for Food Security and Public Health Iowa State University 2004

18. Transmission  Contamination can occur at several points along the food chain  On the farm or in the field  At the slaughter plant  During processing  At the point of sale  In the home Center for Food Security and Public Health Iowa State University 2004

19. Produce Processing Center for Food Security and Public Health Iowa State University 2004

21. Important Organisms  Norwalk-like viruses  Campylobacter  Salmonella  E. coli O157:H7  Clostridium botulinum  Shigella spp  Toxoplasma  Emerging organisms Center for Food Security and Public Health Iowa State University 2004

22. PathogenNo. of Cases Salmonella6,017 Campylobacter5,215 Shigella3,021 Cryptosporidium480 E. coli 0157443 Yersinia161 Listeria138 Vibrio110 Cyclospora15 Total in 200315,600

23. Center for Food Security and Public Health Iowa State University 2004 MMWR

24. Center for Food Security and Public Health Iowa State University 2004 MMWR

25. Center for Food Security and Public Health Iowa State University 2004

26. Norwalk-like Viruses  Norovirus; Caliciviridae family  Most common foodborne agent  23 million cases annually  Sources  Person-to-person  Shed in human feces, vomitus  Outbreaks in daycares, nursing homes, cruise ships  Contaminated shellfish Center for Food Security and Public Health Iowa State University 2004

27. Norwalk-like Viruses  Small infectious dose  Signs  12-48 hours post-exposure  Nausea, vomiting, diarrhea, abdominal cramps  Headache, low-grade fever  Duration: 2 days  Food handlers should not return to work for 3 days after symptoms subside Center for Food Security and Public Health Iowa State University 2004

28. Campylobacter jejuni  Leading cause of bacterial diarrhea  2.4 million people each year  Children under 5 years old  Young adults (ages 15-29)  Very few deaths  Can lead to Guillain-Barré Syndrome  Leading cause of acute paralysis  Develops 2-4 weeks after Campylobacter infection (after diarrheal signs disappear) Center for Food Security and Public Health Iowa State University 2004

29. Campylobacteriosis  Sources  Raw or undercooked poultry  Non-chlorinated water  Raw milk  Infected animal or human feces  Poultry, cattle, puppies, kittens, pet birds  Clinical signs  Diarrhea, abdominal cramps, fever, nausea  Duration: 2-5 days Center for Food Security and Public Health Iowa State University 2004

30. Salmonellosis  Gram negative bacteria  Many serotypes can cause disease  S. enteritidis and typhimurium  41% of all human cases  Most common species in U.S.  1.4 million cases annually  580 deaths Center for Food Security and Public Health Iowa State University 2004

31. Salmonellosis  Sources  Raw poultry and eggs  Raw milk  Raw beef  Unwashed fruit, alfalfa sprouts  Reptile pets: Snakes, turtles, lizards  Signs  Onset: 12-72 hours  Diarrhea, fever, cramps  Duration: 4-7 days Center for Food Security and Public Health Iowa State University 2004

32. 1972 1977 1982 1987 1992 1997 2002 Year 30 25 20 15 10 5 0 Salmonellosis. Reported cases per 100,000 population, by year – U.S., 1972-2002 MMWR Most common serotypes: S. typhimurium, S. enteriditis, S. Newport Rate

33. E. coli O157:H7  Enterohemorrhagic Escherichia coli (EHEC)  Surface proteins; toxin  Sources  Undercooked or raw hamburger; salami  Alfalfa sprouts; lettuce  Unpasteurized milk, apple juice or cider  Well water  Animals: Cattle, other mammals Center for Food Security and Public Health Iowa State University 2004

34. E. coli O157:H7  Signs  Watery or bloody diarrhea, nausea, cramps  Onset: 2-5 days  Duration: 5-10 days  Sequela  Hemolytic Uremic Syndrome (HUS)  Acute kidney failure in children  Life threatening Center for Food Security and Public Health Iowa State University 2004

35. MMWR

36. Botulism  Clostridium botulinum  Neurotoxin leads to flaccid paralysis  Infants at greatest risk  Annually: 10-30 outbreaks; ~110 cases  Sources: Home-canned foods, honey  Signs  Double vision, drooping eyelids, difficulty speaking and swallowing  Onset: 18-36 hours Center for Food Security and Public Health Iowa State University 2004

37. Year 1982 1987 1992 1997 2002 Reported Cases 110 100 90 80 70 60 50 40 30 20 10 0 MMWR

38. Shigellosis  Bacillary dysentery  Most cases Shigella sonnei  90,000 cases every year in U.S.  Sources:  Human fecal contamination of food, beverages, vegetables, water  Signs:  Watery or bloody diarrhea, nausea, vomiting, cramps, fever  Onset: 2 days  Duration: 5-7 days Center for Food Security and Public Health Iowa State University 2004

39. Year 1972 1977 1982 1987 1992 1997 2002 Rate 15 10 5 0 MMWR

40. Toxoplasmosis  Toxoplasma gondii- intracellular protozoan  112,500 cases annually  Pregnant women/immunocompromised at greatest risk  Sources  Infected cats, soil, undercooked meat  Signs  Fever, headache, swollen lymph nodes Center for Food Security and Public Health Iowa State University 2004

41. Emerging Pathogens  Cyclospora (Protozoan)  1996, imported raspberries  Listeria monocytogenes  Sources  Ready-to-eat meats, soft cheeses  Signs  Human abortions and stillbirths  Septicemia in young or low-immune Center for Food Security and Public Health Iowa State University 2004

44. HACCP  Hazard Analysis Critical Control Point  To monitor and control production processes  Identify food safety hazards and critical control points  Production, processing and marketing  Establish limits  Monitor  Applied to meat, poultry, and eggs Center for Food Security and Public Health Iowa State University 2004

45. On Farm Strategies  Testing and removal for Salmonella  Serologic, fecal culture, hide culture  Vaccinating  Many serotypes  Varying effectiveness  Minimize rodents, wild birds  Isolation of new animals Center for Food Security and Public Health Iowa State University 2004

46. At the Slaughter Plant  FSIS target organisms  Salmonella and E. coli  Control points  Removal of internal organs  Minimize contact between carcasses  Proper movement through facilities  Chilling  Cooking processes (time, temperature) Center for Food Security and Public Health Iowa State University 2004

47. Irradiation  Used since 1986 for Trichina control in pork  Gamma rays  Poultry in 1990/1992  Meat in 1997/1999  Reduction of bacterial pathogens  Kills living cells of organisms  Damaged and cannot survive Center for Food Security and Public Health Iowa State University 2004

48. Irradiation  Identified with radura…..  Does not affect taste quality  Nutrients remain the same  Handle foods appropriately afterwards  Does not sterilize  Contamination can still occur Center for Food Security and Public Health Iowa State University 2004

49. USDA Recall Classification Center for Food Security and Public Health Iowa State University 2004

50. In the Home  Drink pasteurized milk and juices  Wash hands carefully and frequently  After using the bathroom  Changing infant’s diapers  Cleaning up animal feces  Wash hands before preparing food Center for Food Security and Public Health Iowa State University 2004

51. Tại nhà  Wash raw fruits and vegetables before eating  After contact with raw meat or poultry  Wash hands, utensils and kitchen surfaces  Hot soapy water  Defrost meats in the refrigerator Center for Food Security and Public Health Iowa State University 2004

52. In the Home  Cook beef/beef products thoroughly  Internal temperature of 160 o F  Cook poultry and eggs thoroughly  Internal temperature of 170-180 o F  Eat cooked food promptly  Refrigerate leftovers within 2 hours after cooking  Store in shallow containers Center for Food Security and Public Health Iowa State University 2004

53. Additional Resources  Centers for Disease Control and Prevention  http://www.cdc.gov/foodsafety/  U.S. Department of Agriculture  http://www.foodsafety.gov  http://www.nal.usda.gov/fnic/foodborne/stateme n.html Center for Food Security and Public Health Iowa State University 2004